What is an inguinal hernia?
An inguinal hernia is the protrusion of intra-abdominal contents (peritoneum, fat, occasionally bowel) through a weak point of the abdominal wall in the groin region — specifically through the inguinal canal. It typically manifests as a soft, painless bulge that becomes more prominent on standing, coughing or straining.
Hernias are classified as indirect (through the internal inguinal ring) or direct (through Hesselbach's triangle). Without surgical repair, hernias never resolve and gradually enlarge. Definitive treatment is exclusively surgical.
How common is it?
Inguinal hernias are among the most common surgical conditions worldwide. The lifetime risk of developing an inguinal hernia is approximately 27% in men and 3% in women. They are 8–10 times more common in men than in women.
Approximately 20 million hernia repairs are performed annually worldwide. In Greece, around 30,000 inguinal hernia operations are carried out each year. The condition affects all ages, but incidence peaks between 50 and 70 years.
How does it present?
The main symptoms of inguinal hernia include:
- Visible or palpable swelling in the groin, more pronounced on standing or straining.
- Feeling of heaviness, discomfort or burning in the groin.
- Pain that may radiate to the testicle or thigh.
- Worsening symptoms with physical effort, prolonged standing, coughing or sneezing.
- Reducibility (the swelling temporarily disappears when lying down or with digital reduction).
- Severe pain, redness, vomiting or inability to reduce — strangulation, requires emergency surgery.
How is it diagnosed?
Diagnosis is primarily clinical:
- History and clinical examination in standing and supine positions, with and without Valsalva.
- Palpation of the inguinal canal and the external inguinal ring.
- Ultrasound of the groin in unclear cases or with the patient on Valsalva.
- MRI in complex cases or to differentiate from other groin pathology (sportsman's groin, lymphadenopathy).
- CT in cases of incarceration or strangulation suspicion.
Which factors increase risk?
There is a familial predisposition to inguinal hernias, with first-degree relatives having approximately a 4-fold higher risk. Genetic variations affecting collagen synthesis (collagen type I/III ratio) appear to play a role.
- Family history of hernia in close relatives.
- Male sex (8–10 times more common).
- Advancing age, with thinning of the abdominal wall.
- Chronic cough (smokers, COPD), chronic constipation, prostatic hypertrophy.
- Heavy lifting, weightlifting without proper technique.
- Obesity or sudden significant weight loss.
- Connective tissue disorders (Ehlers-Danlos, Marfan).
- Previous abdominal surgery.
Modern therapeutic options
The choice of the appropriate technique is individualised for each patient, based on hernia size, type (unilateral or bilateral), recurrence risk and patient preference.
Laparoscopic Repair (TEP / TAPP)
The international gold standard for primary inguinal hernias, especially bilateral ones. Performed through 3 small incisions, with mesh placed in the preperitoneal space. Excellent for athletes and active patients due to rapid return to activity.
Robotic Repair (rTAPP)
For complex, recurrent or bilateral hernias. The Da Vinci system provides three-dimensional visualisation and articulated instruments with 7 degrees of freedom, allowing very precise dissection and mesh placement, especially in challenging anatomy.
Open Repair (Lichtenstein)
The classic technique with anterior mesh placement. Excellent results, particularly for very large or scrotal hernias. Performed under local or spinal anesthesia, suitable for high-risk patients.
Frequently asked questions
Will the hernia heal on its own without surgery?
No. Hernias never resolve spontaneously — they progressively enlarge. The only definitive treatment is surgery. Watchful waiting is acceptable only in elderly patients with very minimal symptoms and high surgical risk.
How quickly can I return to athletic activity?
With the laparoscopic technique, gradual return to light activity is possible in 2 weeks and full athletic activity in 4–6 weeks. With open repair (Lichtenstein), full return takes 6–8 weeks.
Can the hernia recur after repair?
With modern techniques using mesh, the recurrence rate is very low (1–3%). Recurrence risk is increased by smoking, obesity, chronic cough, very large hernias and prior recurrent hernia.
Is the mesh permanent? Are there allergies?
Yes, the mesh is implanted permanently — it is made of biocompatible polypropylene. True allergic reactions are extremely rare. The mesh becomes integrated into local tissue within weeks. There are no specific dietary or lifestyle restrictions.